The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Parapini, Marina L.; Skipworth, James R.A.; Mah, Allison; Desai, Sameer; Chung, Stephen; Scudamore, Charles H.; Segedi, Maja; Vasilyeva, Elizaveta; Li, Jennifer; Kim, Peter T.
• Is Part Of: HPB. Volume 24:Issue 2(2022)
• Page Start: 277
• Page End: 285
• Publication Date: 2022-02
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2021.06.428
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Pre-operative biliary bacterial colonisation (bacterobilia) is considered a risk factor for infectious complications after pancreaticoduodenectomy (PD). This study aimed to investigate the role of the PD biliary microbiome grown in the development of post-PD complications. Methods: In a retrospective study of 162 consecutive patients undergoing PD (2008–2018), intra-operative bile cultures were analyzed and sensitivities compared to pre-anesthetic antibiotics and thirty-day post-surgery complications. Results: Bacterobilia was present in 136 patients (84%). Most bile cultures grew bacteria resistant to pre-operative antibiotics (n = 112, 82%). Patients with bacterobilia had significantly higher rates of major complication than patients without ( P = 0.017), as well as higher rates of surgical-site infections (SSI) ( P = 0.010). Patients with negative bile cultures (n = 26) had significantly lower rates of major complication and SSI than those growing sensitive (n = 24) or non-sensitive (n = 112) bacteria (major complication P = 0.029 and SSI P = 0.011). Conclusion: Positive bile cultures were associated with a higher incidence of major complications and SSI. Patients with sterile bile cultures had the lowest risk of post-operative complications and efforts to reduce rates of bacterobilia, such as limitation of biliary instrumentation, should be considered. Sensitivity to antibiotics had no effect upon the rate of post-operative complications, but this may reflect low cohort numbers.